The significance of retroperitoneal lymph node dissection in stage 1 endometrial carcinoma: A retrospective analysis
Endometrial cancer ranks as the most common malignancy in gynecology and the sixth most common cancer among women worldwide. It typically presents with early symptoms, a vast majority as postmenopausal bleeding.
Consequently, most of these cases present at an early stage, resulting in a generally favorable prognosis and high survival rates. Specifically, early-stage endometrial cancer boasts a five-year survival rate of approximately 85% according to the statistics of International Federation of Gynecology and Obstetrics (FIGO) for stage 1.
Despite the common practice of removing lymph node during surgical management of endometrial carcinoma, its impact on patient outcomes remains uncertain. In 2006, the American Congress of Obstetricians and Gynecologists (ACOG) recommended the use of surgical staging, which often includes lymph node sampling for majority of women diagnosed with endometrial cancers, excluding younger women wishing to preserve fertility and those with high mortality risks due to other medical conditions.
This retrospective study aimed to evaluate the significance of lymph node dissection in the management of stage 1 endometrial carcinoma and the Objective was to analyze the histopathology reports of the patients who underwent RPLND for MRI proven stage 1 endometrial carcinoma and assess the rate of lymph node positivity in the same. All patients with a prior MRI report indicating the presence of Stage 1 Ca endometrium who underwent staging laparotomy in the department of obstetrics and gynecology of the institution during the study period were taken into consideration. Their histopathology reports were analyzed for lymph node positivity.
Analysis was done by SPSS 23. Wilson score test was done. Null hypothesis assumes a zero-percentage positivity. Proportion of lymph node positivity was 1.96 in a confidence interval of 1.34 +/- 2.38 and hence according to study, RPLND did not yield a benefit in MRI proven stage 1 disease.
Study findings indicated that retroperitoneal lymph node dissection did not yield a significant proportion of positive results. This finding is further supported by our narrow confidence interval, suggesting that an increased sample size would likely not alter the outcome. A 2017 Cochrane review and data from the Munich Cancer Registry found that lymphadenectomy for carcinoma endometrial cancer does not reduce the risk of death or disease recurrence in women with presumed stage I disease. Additionally, they found that women undergoing this procedure are more likely to experience systemic morbidity related to surgery and other serious complications.
This retrospective analysis demonstrates that retroperitoneal lymph node dissection does not provide significant benefit in MRI-proven stage I endometrial carcinoma, given the very low rate of nodal positivity observed. The findings support a more individualized treatment approach, reducing unnecessary surgical morbidity without compromising oncologic safety. Sentinel lymph node mapping may serve as a more effective and less invasive alternative in this setting.= Larger prospective studies with longer follow-up are needed to further validate these results and refine management guidelines for early-stage endometrial carcinoma.
Source: Menon and Pattiyeil / Indian Journal of Obstetrics and Gynecology Research 2026;13(2):223–227
